A Unique Approach to Heal a Neonate's Open Abdomen using Gentian Violet/ Methylene Blue Polyurethane Anti-Microbial Foam

Neonatal wound care often presents unique challenges; especially for those born under 26 weeks of gestational age or under 800 grams, often referred to as “micro-preemies”. In the United States approximately 18,000 - 19,000 micro-preemies are born annually, representing 0.46% of all live births (McGarrah, 2015). These patients have barriers to healing and limited wound care choices.

Baby B was born at 24 weeks weighing only 770 grams. He had a spontaneous ileal perforation at 9 days of life, leading to the creation of an ileostomy and mucous fistula. At 38 days of life he developed another bowel perforation which required a revision to his stomas. His generalized edema prevented the surgical team from closing his abdomen, so it was left open with a silo, sutured to the edges. After 11 days, with the silo constantly leaking, he was becoming septic. His stoma and mucous fistula were 1 cm away from the wound edge and the stoma had swollen to 57mm x 41mm. The surgical team requested an alternative treatment plan.

The Enterostomal Therapy Nurse (ETN) had previously cleared the use of gentian violet/ methylene blue polyurethane (GV/MB PU) anti-microbial foam for this population with the neonatal pharmacists. This foam was deemed appropriate because there is no deposit of chemicals onto the skin. The ETN suggested the application of the GV/MB PU foam. The dressing was secured using an ostomy wafer, with a one-piece adult fistula appliance placed over. The dressing was changed every three to four days.

Within seven days the exposed bowel was covered with granulation tissue, and there was advancing epithelium.

This case describes the successful use of a GV/MB PU foam for a micro-preemie’s open abdominal wound. Each patient will present with unique challenges and dressing selections should always be tailored to fit the patients’ needs.